Bipolar Disorder

Summary

Bipolar affective disorder is a recurrent, long term mood disorder characterised by the presence of both depressive and manic phases. It involves substantial morbidity with a high suicide risk, and frequently causes a variety of psychological and social problems.

The primary goals in the management of patients with bipolar disorder are the treatment of acute depressive and manic episodes and the prevention of future affecti ve episodes. Other equally important goals are interepisodic mood stabilisation and the reduction of excess mortality, mostly caused by suicide. Long term treatment of bipolar disorder requires the development of an overall psychiatric management strategy, that addresses many issues such as pharmacotherapy. informing the patient about the course and treatment of the illness. and supportive psychotherapy.

Specific drug treatments are the most important tool in the treatment of bipolar disorder. Lithium is regarded as the drug of first choice for prophylaxis against bipolar disorder. In a number of controlled investigations, lithium has been shown to be preventive and mood stabilising by substantially reducing the frequency, duration and severity of future episodes. Carbamazepine is being used increasingly as an alternative to lithium in patients who fail to respond to lithium prophylaxis. Novel pharmacological alternatives for the prophylactic management of bipolar disorder include valproic acid (sodium valproate), highdose thyroxine and specific drug combinations (such as lithium and carbamazepine or valproic acid).

Lithium is the drug of choice for the immediate treatment of acute mania. either on its own or in combination with anti psychotics. Alternatives are primarily valproic acid and carbamazepine. The treatment of the depressive phase is often complicated by the potential risk of an antidepressant-induced rapid change to a manic phase. However, the treatment of depression in patients with bipolar disorder does not generally differ from the treatment of unipolar depression.

Keywords

Lithium Carbamazepine Clozapine Valproic Acid Affective Disorder

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